Transition from DreamStation 2 to AirSense 10

[prince01]

I switched from a DreamStation 2 to an AirSense 10 about 6 weeks ago using the same settings on the AirSense 10 as I had been using on the DreamStation 2.  APAP mode, minimum pressure 9.0, maximum pressure 15.0, EPR at the highest setting.  Autoramp is on with a minimum prssure of 4.0.

The good news is that OAs are now 3 or less a night (~7 hours), hypopneas pretty much unchanged.  The bad news is that CAs went up dramatically.  Turing EPR off reduced the CAs but drove the hypopneas way up.  Reducing maximum pressure to 13.0 and setting EPR to 2 reduced the hypopneas but drove the CAs back up - OAs remaining low to nonexistent through all this.

Is it possible my maximum pressure is still too high at 13.0?  Would a lower EPR setting help?  Note also that I typically have very few, if any, events during the lower pressure ramp period.

While I know the therapy I'm receiving is technically"acceptable", I still think there is room for improvement.

Any suggestions?

Last night's OSCAR screenshot is attached.

[sauerkraut]

prince01;
I really don't have the experience to suggest settings ..
But the research I've done, It seems the best advice is use the settings
that leave You feeling better !! Work from there to improve ..
After all isn't the bottom line to get a good nights rest and be alert
during the day !!
Best of Luck !! Steve

[PeaceLoveAndPizza]

First, how did you end up with your current settings and how do you feel in the morning? 

Some observations…

Your flow limits are a bit high and driving up pressure. You can try setting EPR to 3 and see how it feels. It would help to see the flow limit graph as it is a likely culprit for your pressure swings.

Do you need ramp? If not turn it off as you do not get therapy during the ramp time.

If you are open to trying things, try setting your pressure to 8-15 EPR 3. This should tell us a lot about how much pressure you need to handle the apnoea’s, then we can fine-tune from there for the CA’s.

Everything else looks pretty good. You have done well finding a range you can live with and also in trying to improve it even more.

[Crimson Nape]

You may be sensitive to the pressure changes. Based on your flow limit, your pressure will go to your set maximum. You might try setting a min/max setting of 13 and an EPR of 1. This will make the pressure static for IPAP at 13 and an EPAP of 12. The higher EPAP should address the hypopneas. One night should show if this is the correct path.

- Red

[prince01]

Agree completely sauerkraut!

Mixed results there - sometimes I do feel rested the next morning, other times, not so much.  That's largely the reason I am trying to further optimize my therapy.  I'm simply interested in getting the best night of sleep possible and doing so with consistency.

[prince01]

PeaceLoveAndPizza,

Thanks for your response.

Here is a brief synopsis of setting history:

My original setting was a static 7 set by my sleep doctor and resulting in an average AHI of ~8 - down from 29 during my sleep study.  I complained to the PA about the therapy being suboptimal and the settings were then changed to 5-15.  This resulted in an average AHI of ~5.  After 5 months with no indication that the sleep practice was paying attention to my data and a follow-up appointment 8 months out, I began changing my own settings arriving at 9-15 resulting in and average AHI of 1.4.  All this is with DreamStation/DreamStation 2 equipment, AFlex at level 3.  Then I decided I wanted to move away from PR to ResMed.  The two brands have very different control algorithms and the settings I had been using with the DS2 didn't work so well.  That's brings us to the most recent 6 weeks with the AirSense 10.

As I said to sauerkraut, mixed result on how I feel in the morning leading to my desire to improve the quality and consistency of therapy.

Related to your other questions:

• Probably don't need the ramp, makes it a bit easier to nod off and not seeing many if any events during the short duration of the ramp.  I could likely turn it off with few if any ramifications.
  
• Yes, I am open to trying things.  I have used settings very close to the ones you are suggesting I try - 9-15, EPR 3.  Screenshot attached from the most recent session with the AirSense 10.
  

Please have a look and tell me what you are thinking.

Thanks again!

[prince01]

Crimson Nape,

Thanks for the response.

Are you suggesting a static pressure of 13?

BTW, here is a screenshot of last night's session with the flow limitation graph visible.  9-13, EPR 2.

[Crimson Nape]

Yes, static. I would turn off the ramp too. It is delaying your therapy and may cause an arousal when it transitions from the low pressure to your normal pressure.

- Red

[prince01]

Crimson Nape,

I will try that tonight and report back on the results.

[prince01]

Crimson Nape,

Screenshot from last night's sleep attached.  Interested in hearing what you make of it.